Provider Demographics
NPI:1871141853
Name:CROUCHER, CARMEN (LPCC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CROUCHER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 INDIA ST STE 103-1067
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2445
Mailing Address - Country:US
Mailing Address - Phone:619-786-7187
Mailing Address - Fax:
Practice Address - Street 1:1501 INDIA ST STE 103-1067
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2445
Practice Address - Country:US
Practice Address - Phone:619-786-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC8286101YM0800X
CA8286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health